As I have discussed before, proponents of alternative therapies generally, including homeopaths, tend to rely heavily on case reports as supporting evidence. Case reports are simply structure, published anecdotes, and while they are useful for suggesting hypotheses to test, they prove absolutely nothing. They are no more reliable than any other medical miracle story.

Yet the AVH goes so far as to call their annual meeting “The AVH Annual Case Conference,” and the journal reports almost exclusively anecdotes and no formal, controlled studies. Though there are controlled clinical trials done to investigate homeopathy (which, when looked at carefully, do not support any real effects), homeopaths still rely on uncontrolled individual observation as the core type of evidence both to validate specific homeopathic interventions and to guide the development of the discipline. This is fundamentally inconsistent with scientific and evidence-based medicine, which recognizes the low reliability and high risk of bias associated with such evidence.

Many of the case reports share some common elements:

There is no objectively confirmed definitive diagnosis.

Conventional therapy (whether appropriate or inappropriate) is identified as having failed.

Conventional medical practices are frequently implied to have caused or worsened the problem.

Homeopathy is claimed, or implied to have cured the problem.

All of these cases are therefore emotionally compelling arguments against conventional medicine and for homeopathy which, unfortunately, include absolutely no control for bias or error and actually prove nothing. This is marketing, or perhaps more accurately proselytizing, masquerading as science.

Here are a couple of examples:

a three-year-old miniature stallion…presented with acute and persistent seizure activity which occurred a week after a rabies vaccination coupled with a very traumatic tooth floating experience. The complementing video clips clearly demonstrated the symptoms, patient care and the progression to full recovery!

a two-year FS, mixed breed dog presented after an array of suppressive and intensive therapy (including a ligated carotid artery) for a chronic purulent and bloody nasal discharge. Once every(!) diagnostic and therapeutic technique had been tried, [the owner] turned to homeopathy. [The homeopath], using Aurum, guided [the pet] and her guardian through the re-emergence and eventual clearing of suppressed skin, emotional, digestive and nasal symptoms.

A family crisis results in a serious symptom emerging [in a MN DSH]: a suspected nasal squamous cell carcinoma…Gradual, ascending potencies (along with nutritional support from CoQ10, Standard Process Cataplex ACP and Feline Immune Support) resolved all symptoms. Since the last remedy, he has remained well for over a year. [This illustrates] Aphorism 17 regarding cure: “through taking away the entire complex of perceptible signs and befallments of a disease, the internal alteration of the life force which is lying at its base (consequently the totality of the disease) is simultaneously lifted.”

one of her patients was sent home to die in an anemic almost comatose state after diagnosis with inoperable bleeding tumors. Her courage and patience in prescribing assisted this very fragile individual to make what so far is a complete and miraculous recovery.

Apart from a misleading emphasis on uncontrolled anecdotes, the AVH journal illustrates the inconsistent attitude of the veterinary homeopathy community towards science and the disingenuous use of scientific research as a marketing tool.

Dr. Shelley Epstein is one of the most prominent homeopaths claiming that homeopathy is a proven and scientifically legitimate field. I have responded to her arguments in detail before (The Science of Homeopathy?, The Evidence for Homeopathy-A Close Look). Essentially, she simultaneously claims that randomized clinical trials support the efficacy of homeopathy (referring primarily to poor quality positive trials with high risk of bias and completely ignoring better quality negative trials and the systematic reviews of the literature which show no convincing evidence of a clinically measurable effect beyond placebo) and argues that typical RCT design is inappropriate to apply to “individualized” homeopathic therapy.

In this issue of the AVH journal, Dr. Epstein is reported as continuing to assert that there is consistent and reliable evidence for the mechanism and benefits of homeopathy, despite the lack of acceptance of this evidence by anyone in the scientific community, apart from practitioners of alternative therapies:

We have moved well beyond whether homeopathy can be measured, into being able to measure nanoparticle quality control issues among the starting homeopathic products; measure specific frequency differences between remedies and their potencies; measure variation in particle and aggregate size and shape; and measure elemental composition of the homeopathic particles. Studies are finding out how nanoparticles remain dispersed in solution via the hypotheses that trituration generates nanofraction formation, lactose acts as stabilizer to prevent aggregation, dilution allows larger raw particles to settle out and nano-clusters to disperse freely in the medium. Other research involves remedies as nanomedicines and how their dissolved silicate structures carry remedy information into the body.

I have discussed the subject of “nanoparticles” as a validation of homeopathy elsewhere. I have also previously addresses the subject of “hormesis,” which Dr. Epstein also attempts to stretch from a narrow scientific phenomenon having nothing to do with homeopathy into some kind of scientific validation of homeopathic principles. Such misuse of nanoparticle physics, quantum physics, and other obscure but legitimate scientific fields is a hallmark of pseudoscientific rationalizations of alternative therapies.

However, even more dramatic examples of pseudoscience taken seriously are available in the AVH journal.

One speaker openly discusses the true nature of homeopathy as a form of spiritual healing, a religious belief rather than an approach to medicine compatible with science:

Let’s look at Aphorism11 of the Organon:”…initially only the spirit-like, autonomic life force…is mistuned… Only the life principle…can induce in the organism the irregular functions that we call disease.” We know this, but it is still easy to get lost in the perceptions of material agents as causes of disease. When we use vision in homeopathy, it is not to observe the causal agent but to perceive the effects of this disturbance of the life force….Homeopathy is right in the mix with a growing evidence base to show that homeopathic preparations can affect gene expression. While gene expression is in the physical realm, it can be altered via an energetic medicine.

And in his presentation, the legendary veterinary homeopath Richard Pitcairn

continues to stretch our perceptions of time and reality. Thought provoking indeed was the discussion of multiple personalities. Some with individual disease processes were definitely confounding. In one personality there would be a documented severe eye injury which would completely and instantly disappear as he shifted to his other personality….Some multiples changed eye colors between the personalities.

How the AVH can simultaneous claim scientific legitimacy and promote nonsense like this is truly mysterious. However, the AVH appears to recognize that homeopathy has an image problem (though not that this problem is that too many vets recognize it for the pseudoscience that it is). The journal editor speaks directly to this subject:

holistic or CAVM or integrative veterinary medicine is taking a more prominent role. With that increased visibility and scrutiny comes the need to act and practice responsibly. We have often been viewed as the insurgents in veterinary medicine and…it behooves us to present ourselves in a more conventionally professional way. I think we need to be aware that every column we write, every blog we post or forum letter we write can have a far-reaching impact. This is doubly true if we are venting or criticizing colleagues, organizations or disciplines.

I certainly support respectful, substantive disagreement within the veterinary profession, and I have often been disturbed by the extreme, sometimes religious zeal with which proponents of alternative therapies sometimes respond to quite polite and evidence-based critiques of their methods. For example, one prominent supporter of homeopathy responded to the CVMA resolution presented to the AVMA by linking it to the Holocaust. Another once responded to a post of mine criticizing the American Holistic Veterinary Medical Association (AHVMA) by calling me a “shill for the pharmaceutical companies” and claiming that “threatened financially and ideologically, [he] must resort to political tactics of attack, shock and awe using headlines inspired by the National Inquirer or some other ladies gossip rag.”

To be fair, I too have sometimes been guilty of letting my emotions get the better of me and expressing my objections to specific practices in an excessively personal and inflammatory way, especially in the early days of blogging about the subject. However, I think it is a greater problem that healthy debate about the merits of alternative therapies is often impossible due to the passionate hostility that often greets any criticism of such approaches. It would be better for our profession if we could keep our disagreements civil and focused on ideas and evidence.

Unfortunately, I suspect this call for a more thoughtful tone in responding to critics of homeopathy may be more about perception and public relations than a true desire for substantive and respectful engagement. This suspicion is heightened by the announcement in the AVH journal that,

The AVH has hired a public relations representative. Peter Gold has experience working with the National Center for Homeopathy (NCH) and other organizations. Our goals are to increase awareness about homeopathy, build membership and raise funds for AVH.Your contributions (case testimonials, anecdotes, homeopathy tips etc.) are also needed….

AVH is blessed to have marketing director Peter Gold, who has been very helpful promoting AVH and homeopathy. His latest accomplishment was establishing a connection with Dogs Naturally magazine. I’d like to give everyone a gentle push to submit your success stories to Peter and the magazine. This is an excellent opportunity to get the word out about homeopathy.

The summer issue of the AVH journal also provides an update on the AVH lawsuit against the AAVSB. The AVH lost their case at every level, including a final failure on appeal to the Virginia State Supreme Court. However, they still consider it a worthwhile effort:

There was speculation that perhaps the AVH’s stand against AAVSB may have been the instigation for much of the current interest in homeopathy, reorganization of the holistic review committee of RACE and the impetus for other similar suits from holistic veterinary organizations.it was well worth the fight and achieved some worthy goals.

It is telling that the AVH has a legal advisor who has helped them pursue a 4-year lawsuit and now a marketing and public relations advisor, both employed to promote homeopathy by means other than rigorous scientific research. This illustrates the purpose of this organization, which is to function as an advocacy and marketing agency and a support group for practitioners of homeopathy, not as a scientific “academy” investigating homeopathy in an objective way. Homeopathy is a faith-based system in which scientific evidence is never a reason to question or reject existing dogma. The selective use of research findings by the AVH is not about discovering the truth but about developing marketing tools to create the impression of scientific validity.

There’s nothing inherently wrong with promoting a practice one believes in, of course. It is simply worthwhile for anyone evaluating the claims or evidence put forward by the AVH and its members to be aware that the organization is not interested in questioning or investigating the dogma of homeopathy in any objective way, and that scientific evidence is only employed by this group as a marketing tool, not as an impartial guide to what is true or false. While the group may claim that science supports homeopathy, this claim is inconsistent with

The AVH’s promotion of blatant mysticism and pseudoscience such as illustrated by this journal

The AVH’s use of litigation and public relations efforts to gain acceptance for a practice that cannot be effectively promoted on the basis of its scientific merits

The selective and biased use of scientific research to promote an unshakable belief rather than to identify effective and ineffective therapies.

The AVH purports to represent the mainstream beliefs and attitudes of veterinary homeopaths. If this is true, then there is no better illustration of why homeopathy as a discipline is inconsistent with science and should not be viewed as a legitimate veterinary therapy. The scientific evidence is clear and consistent that homeopathy is nothing more than a placebo, and all the litigation and public relations spin the AVH generates can do nothing to alter this.

16 Responses to The Marketing of Veterinary Homeopathy

Just reading your article here and only the first few paragraphs of the pdf file, my head is spinning. No surprise there, but with each new finding of their activities, it defies belief just how low they will stoop to further their agenda.

My first reaction was to call them out for what they are – liars. To say it more gently, it’s Homeopaths Gone Wild.

Will Falconer, DVM and homeopath posted the following comment elsewhere on 6/2/13. I have his permission to post it here.

I think the heart of it lies in our not being able to understand HOW homeopathy works. We just don’t. It doesn’t follow the laws of Newtonian physics, that’s a given. When people can’t understand how something CAN work, it’s easier to assume that it doesn’t, and write others off as delusional who know differently.

And yet it works. On animals. On children. Neither of which know how to put on a placebo response. And it works in adults, too of course, independent of their “believing” that it will work.

In homeopathic veterinary practice, I see serious illnesses that turn around with the careful application of homeopathic medicine, following the guidelines of the masters of old. These animals were not getting well with all that conventional medicine had for them, and their owners often spent thousands of dollars trying.

While treating chronic illness of a serious nature is not easy with homeopathy, I can often get results in a positive, curative direction pretty early on in the course of treatment. And the animals are “harsh critics” if you will — if they don’t receive a correct remedy prescription, they just don’t get better. And, it’s back to the drawing board, trying to analyze in a new way, looking for a better remedy.

When a proper remedy is found, the results in the sick animals are profound. Not only does the “chief complaint” get significantly better, but other positive effects come to light. The dog who came in with itchy, allergic skin, may also respond positively in becoming less aggressive, more social, as the skin disease improves. The teeth often get cleaner, the breath improves, the joints get more limber. When we see several different organ systems all improving at the same time, we’re confident the remedy made a deep, curative difference in the patient.

In my mind, there’s no better proof that homeopathy works than in veterinary homeopathic practice. You’d have a hard time telling an overjoyed animal owner that her animal got this much better due to “quackery.”

I am familiar with the literature on homeopathy, and there are detailed analyses of many of the papers at the links below. The reality is that when looked at closely, the studies rarely control for potential bias effectively or at all. That is why systematic reviews of homeopathy trials consistently find that the better the quality of the study, the less likely any effect will be seen:

In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos. We could find no support from independent experts for the idea that there is good evidence for the
efficacy of homeopathy.

Biases are present in placebo-controlled trials of both homoeopathy and conventional medicine. When account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.

Conclusion of a systematic review of all the systematic reviews of the homeopathy research literature:

Electronic databases were searched for systematic reviews/meta-analysis on [homeopathy]. Seventeen articles fulfilled the inclusion/exclusion criteria. Six of them related to re-analyses of one landmark meta-analysis. Collectively they
implied that the overall positive result of this meta-analysis is not supported by a critical analysis of the data.

Eleven independent systematic reviews were located. Collectively they failed to provide strong evidence in favour of homeopathy. In particular, there was no condition which responds convincingly better to homeopathic treatment than to
placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo.

It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice.

The problem here is that you are saying, in essence, it doesn’t matter if there is proof of how homeopathy works or even proof that it does so long as some people believe it works based on their personal experience. But there is no therapy ever tried that hasn’t looked like it worked. Either you believe science is the best way to decide what works or what doesn’t or you give up entirely on distinguishing between true and false and let everyone use whatever methods they have personal faith in. That leads us back to the prescientific age of medicine in which half of us didn’t leave to see adulthood and most died before 50 years of age.

Bloodletting was wildly popular among millions of people for thousands of years, and it did far more harm than good. Anecdotes are not data and belief is not evidence. Either something can be demonstrated to be effective through proper scientific investigation or it can’t. If it can’t, then continuing to believe in it takes us out of the realm of medicine and into the domain of religion and faith healing. And while you are of course entitled to believe in whatever you wish, our clients have come to expect that we base our therapies on science rather than personal faith, and history has shown that doing so works much better for our patients.

Modulation of Arthritis in Rats by Toxicodendron pubescens and its Homeopathic Dilutions

Background : Toxicodendron pubescens P. Mill (Anacardiaceae) known in homeopathy as Rhus toxicodendron (Rhus tox) is used as an anti-inflammatory medicine in homeopathic practice. In this study, Rhus tox in its crude form and homeopathic dilutions (3cH, 6cH, 30cH, 200cH) was evaluated for effects on Complete Freund’s Adjuvant (CFA) induced arthritis in rats.

Method: We assessed the severity of arthritis through observations including inflammatory lesions, body and organ weight and hematological parameters including C-reactive protein (CRP). Blinded radiological analysis of the affected joints and pain intensity determination was also carried out.

Results: Rhus tox protected rats from CFA-induced inflammatory lesions, body weight changes and hematological alterations. Rhus tox protected against radiological joint alterations due to arthritis. Arthritic pain scores were also favorably affected by Rhus tox. All the dilutions of Rhus tox including crude form showed anti-arthritic activity. The maximum protective effect was evident in the crude form at 10 mg/kg/day, by mouth.

Conclusion: This study supports claims in the homeopathic literature on the role of Rhus tox and its ultra dilutions in the treatment of arthritis and associated pain. Further study is needed to explain this anti-arthritic effect of Rhus tox.

Sandra,
I would appreciate seeing a full-text copy of this report. As you can tell if you take the time to look at the critiques I’ve linked to above, I have read hundreds of papers purporting to validate the claims of homeopaths, and nearly all of them fail on some level:
1. Absent or inadequate control for confounding, bias, chance, or other sources of error.
2. Cannot be replicated.
3. Do not actually directly address the question of whether or not ultadilute homeopathic remedies have clinically menaingful biological effects.

In particular, the in vitro studies often follow the path blazed by Benveniste: A study looks promising and then the reuslts either disappear when appropriate controls are employed or they cannot be replicated by anyone other than the opriginal investigator. Such single studies cannot balance the overwhelming body of negative evidence already available.

None of your links led to any actual evidence, just other homeopaths claiming that homeopathy works. If you want to discuss the actual scientific evidence, you are welcome to do so, but link spam to homeopathy propoganda isn’t useful.

Just doing a slight bit of digging, it would appear neither Malik nor Hermann are capable of engaging in rational discussion, but are quite skilled in link spamming on forums, blogs and media articles.

You are welcome to post actual information or links to published scientific articles. However, posting multiple links to other people’s anecdotes and claims without any actual evidence is just a form of link spam, and those links will not be posted.

Indiana, a Lucky Dog an article by Shelly Epstein, a veterinarian who combines homeopathy with her practice. Source for entire article with before and after photos is provided.

“Indiana was running out of options. He had been suffering from severe bone destruction in his head as a result of an advanced and uncommon fungal infection, nasal aspergillosis. He was in extreme pain- even picking up a toy with his mouth was too painful. He had received the finest and most advanced care at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, including intranasal infusions of clotrimazole, CT scans, and endoscopy, but was not responding. After months of trying, his doctor had discussed euthanasia with his guardians. The owners decided to come to me for a holistic opinion. At the time of the first consult, they were paying $800 a month for itraconazole, an antifungal drug, although their most recent purchase was reduced to $300 a month thanks to the discovery of a Canadian pharmacy! Indiana was not responding to this medication or to the numerous other antibiotics that were prescribed for the secondary bacterial infections. At the first visit, I discussed how homeopathy could help.”

Nope. Homeopathy and other alternative medicine propoganda web sites don’t count. Dr. Epstein has published a case report on this subject in a veterinary journal, and while it still proves nothing, that is the only link that is appropriate.

I’ll even give you the reference:
Epstein, S. Hardy, R. Clinical Resolution of Nasal Aspergillosis Following Therapy with a Homeopathic Remedy in a Dog. Journal American Animal hospital Association 2011;47:e110-e115.